Having recently concluded, the end of the 77th Texas Legislature marks the beginning of a new two-year cycle leading up to the 78th legislative session.

Though the Legislature is only in session five months every two years, effective legislative advocacy is executed long before the session begins. Active and on-going participation in legislative interim studies, policy development and the election cycle will determine our success next session.

The perfect storm scenario

Converging factors (start with a bad economic climate, remove most public officials with health policy expertise, add an increased need for public assistance at a time when the state is looking for ways to ratchet down costs) have the potential to create a “perfect storm” scenario moving into next session.

The budget forecast for next session is tenuous at best. State leaders are predicting Texas could face a $6 billion shortfall over current funding levels. The possibility of an economic downturn could have even more serious implications for the state budget including less tax revenue, a greater than anticipated budget shortfall, and increased welfare and Medicaid enrollment. All of these factors are intensifying at a time when health care costs to the state are exploding.

Complicating the economic policy concerns will be the chaos created in a post-redistricting session. Virtually every statewide office is up for grabs, as well as every seat in the U.S. House of Representatives, Texas Senate and House of Representatives. Some analysts are projecting turnover rates in the range of 30 to 50 percent. If the turnover projections are correct, it will create a political environment with much less institutional memory and a loss of legislative health policy expertise.

Contact the TAFP Legislative Department:

 Tom Banning, Director of Legislative Affairs

Greg Herzog, 
Legislative Aide

Visit the Member Advocacy section of the Web Site

Getting a Running Start

Understanding the sheer number of issues likely to generate debate next legislative session, the Lt. Governor and Speaker of the House assign issues to various standing or special committees to study. These interim studies are designed to provide more in-depth discussions of emerging issues.

Health care related issues will, no doubt, top the agenda next legislative session, which means TAFP will have to closely scrutinize and monitor these interim studies and give testimony where needed to ensure that the concerns of physicians and their patients are adequately addressed.

Interim studies have yet to be assigned by the Speaker of the House, but four select or special committees have been named and the Lt. Governor has issued the Senate standing committees to study the following:

Senate Special Interim Committee on Prompt Pay of Health Care Providers: charged to evaluate current state law and agency rules designed to ensure the prompt payment of health insurance claims to providers by insurance companies and recommend ways to improve the process.

Joint Select Committee on Public School Finance: charged to conduct a comprehensive review of the public school finance system in Texas. Includes examining the revenue resources for funding public schools and a review of the state’s tax system as it relates to public school finance.

It is widely believed that this committee could make recommendations to the Legislature to change the current tax structure to include a professional service tax on sole proprietorships and group practices or to increase professional licensing fees.

Joint Interim Committee on Health Services: charged to monitor the administrative re-organization of Medicaid and CHIP, Medicaid cost containment activities, acute health reimbursement rates, caseload and cost projections, federal action affecting both programs and any other items identified as relevant by the committee.

Joint Interim Committee on Higher Education Excellence Funding: charged to review current higher education funding formulas and the Texas Higher Education Coordinating Board’s procedures. This committee will likely also look at graduate medical education funding.

Joint Interim Committee on Long-term Care:  charged to make recommendations on any changes needed to improve the quality of nursing home care, assure effective use of public funds for resident care, and improve affordability of nursing home liability insurance.

Senate Special Interim Committee on State Employee Compensation and Benefits: charged to review the cost and use of state employee benefits. This will include an examination of the ERS/TRS systems.

Senate Education Committee: charged to monitor and evaluate the implementation of the teacher’s health insurance plan.

Senate Finance Committee: charged to study the impact of rising medical costs on the state budget; to evaluate methods health and human services agencies use to assess the demand for services and allocate funding; and evaluate the infrastructure, capacity and funding to trauma care to recommend ways to increase funding for the state’s trauma care centers.

Senate Health and Human Services Committee: charged to review selected mental health and mental retardation issues, including the availability and adequacy of mental health services for children, the community health services delivery structure and the Texas Department of Mental Health and Mental Retardation’s method for delivering funds to local communities. 

While these are only a handful of the interim studies legislators will be examining, TAFP will also be identifying and pushing forward on other public policy fronts including: professional liability reforms, medical errors, and other private sector managed care reforms.

Musical Chairs

Phil Gramm’s surprise announcement that he would not seek re-election to the U.S. Senate seat has set off a mad scramble in both political parties to fill his seat. A number of candidates from both sides of the aisle are lining up to fill the void.

Gramm’s decision also has significant down-stream implications. A tsunami of individuals look to fill the seats left open by those seeking higher office. Virtually every statewide office—from Governor to the Texas Supreme Court—will be on the ballot, with a number of those being open seats.

Adding to the confusion, a post-redistricting free-for-all is expected in both the Texas Senate and House of Representatives. The current redistricting plan, which is being challenged in court, pairs 37 House members and creates 20 new open House seats. The plan also gerrymanders a number of districts, changing their partisan make-up, resulting in districts that will be much harder for some incumbent legislators to win.

These factors will, in turn, produce a lot of new faces not only in the Texas Legislature, but in statewide offices as well. This target-rich environment will present TAFP significant opportunities to help elect candidates that are supportive of our issues. TAFP, through TAFPPAC and our Key Contacts program, will be working overtime to educate political candidates about issues important to family practice.

A Call to Action

Given the unprecedented number of health care issues likely to be debated next session and the lack of health policy expertise in the Legislature, physicians must be engaged during the interim.

Like it or not you are involved in politics. In this day and age, state and federal lawmakers are making decisions that directly affect your patients and your practice.

Physicians will get from the political process what they put into it. For those who retreat with an apology, “I’m not involved with politics,” Dr. Mike McKinney has a message. The Centerville general practitioner and three-term legislator will tell you, “If you practice medicine in Texas you are involved in politics. You may not be participating, but you are involved.”

Becoming involved in TAFP’s legislative program through political action support, grassroots involvement, and or policy development will help ensure family practice has a strong voice at the Capitol when the Legislature reconvenes in 2003. 

For more information on what you can do, please call TAFP headquarters and ask for Tom Banning or Greg Herzog at (512) 329-8666 or you can send an e-mail to tbanning@tafp.org.